Background Any preoperative diagnostic assessment that can predict the success of the operation in acromegaly will provide a positive impact on overall remission rates. The aim of this study is to present whether signal intensity on T2-weighted Magnetic Resonance Imaging could predict postoperative results in acromegaly patients. Methods We analyzed our surgical results in regard to T2-weighted images in newly diagnosed consecutive 124 patients with acromegaly, operated between 2014 and 2019.

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... e T2-intensity of the pure somatotroph adenomas was correlated with the clinical, radiological, surgical and histopathological characteristics of the acromegaly patients. Results We found a predominance of T2-hyperintensity in our series (45%) and the T2-hypointense pure somatotroph adenomas were detected in only 34% of our patients. Total resection was performed in 72% of newly diagnosed acromegaly patients in this series. Accordingly, total resection was achieved in 69% of the T2-hyperintense group, 77% of the T2-hypointense group and 69% of the T2-isointense group. The surgical remission rates for the T2-hyper-, hypo- and isointense groups were 55%, 80%, and 69%, respectively. The surgical remission rate in the T2-hyperintense group was significantly lower than those of hypo- and isointense groups in newly diagnosed acromegaly patients. Conclusions This study demonstrates a close relationship between the T2 signal intensity and the surgical remission rates in acromegaly. T2 signal intensity seems to be an indicator of the degree of surgical resection completeness in pure somatotroph adenomas. The implications suggest that preoperative T2-intensity may directly predict the probability of post-surgical remission as an important independent factor in patients with newly diagnosed acromegaly.